The increasing prevalence of musculoskeletal disorders in the workplace has been identified as one of the most costly health concerns faced by industrialized nations. Epidemiologic studies suggest that both physical and psychosocial factors play a critical role in the development of work-related neck pain, yet interactions among these risk factors remain poorly understood. The underlying cause of chronic neck pain remains undiagnosed for the majority of cases, likely resulting in suboptimal treatment for many individual patients. The overall goal of this project is to assess the validity of a new screening protocol to identify stress-evoked muscle activity that may either cause or exacerbate neck pain in susceptible individuals. Aim 1 will use a case- control study design to assess the discriminant and concurrent validity of a standardized screening protocol to detect elevated psychomotor responses to stress in subjects with and without chronic neck pain. Aim 2 will use a prospective study design to determine the predictive validity of this screening protocol by assessing the risk of developing chronic neck pain in asymptomatic office workers during the first year of employment in a high-risk occupation. This aim will also determine the diagnostic cutoff score for stress-evoked muscle activity that best predicts the future development of chronic neck pain. Findings from this project will inform the design of future clinical trials by providing a validated tool to identify subgroups of individuals that are most likely to benefit from stress-management interventions to prevent or treat chronic neck pain, which will ultimately improve clinical decision-making for practitioners who treat this disorder. This project will also provide new information on modifiable physical and psychosocial risk factors for chronic neck pain, consistent with research priorities outlined by a multidisciplinary task force of experts in the field. PUBLIC HEALTH RELEVANCE: The Bone and Joint Decade Task Force on Neck Pain recently recognized a need for studies to identify clinical subgroups of patients that are most likely to respond to specific types of treatment. This Task Force further emphasized the need to better understand how psychosocial and physical exposures at work interact with each other to cause neck pain, and to identify modifiable risk factors to prevent the development of neck pain. This project will develop and test a new clinical tool to screen for elevated muscle activity in response to stress. This information will be used in future clinical trials to determine whether stress-management interventions can be used to reduce excessive muscle activity that either causes or exacerbates neck pain in susceptible individuals.